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Determinants of tuberculosis in an immigrant population in Rome: a case-control study
E Rapiti1, V Fano, F Forastiere
1Department of Epidemiology, Regional Health Authority, Rome, Italy.
Setting:
An out-patient clinic for immigrants in Rome, Italy.
Objective:
To determine risk factors for tuberculosis among immigrants in Italy.
Design:
Case-control study. Cases comprised 44 individuals aged 15-55 years who had a first diagnosis of tuberculosis between 1989 and 1994 at the clinic. Controls comprised 264 individuals randomly recruited among immigrants who attended the clinic for other reasons within seven days before or after the case was diagnosed. Subject information included country of origin, date of first arrival in Italy, level of education, knowledge of the Italian language, and legal resident status.
Results:
An increase of tuberculosis risk was observed with increasing tuberculosis incidence in the country of origin. Multivariate analysis showed an increased risk for those coming from Central and South America (odds ratio [OR] 5.5; 95% confidence interval [CI] 1.6-18.7). The adjusted odds ratio by time since entry in Italy increased during the second year of residence (OR 2.8; 95% CI 1.1-7.0), but decreased after that period. A trend toward increasing risk with decreasing educational level was observed.
Conclusions:
These results demonstrate the need for a public health policy in Italy for tuberculosis control among immigrants which includes screening, prophylaxis and treatment.